Application for Change in Managing Officer - City of Cape Girardeau, Missouri

City of Cape Girardeau, Missouri

401 INDEPENDENCE
P.O. BOX 617
CAPE GIRARDEAU, MO 63702
Phone: 573-334-1332 Fax: 573-335-7946

Application for Change in Managing Officer

City of Cape Girardeau Seal

____	3.2% Non-Intoxicating Beer by Drink
____	5% Beer by Drink
____	Retail Liquor by the Drink
____	Original Package 3.2% Beer
____	Original Package 5% Beer
____	Original Package Liquor
____	Wholesalers of Malt Liquor not in excess of 5%
____	Wholesalers of Intoxicating Liquor in excess of 5%

1.	The full name (and maiden name if applicable) of the managing officer of the corporation for which this license is sought is ________________________________ Drivers License No. ____________________
2.	The place of residence of the managing officer is ______________________________
3.	How long immediately preceding the date of this application has he/she lived there?_______
4.	What was his/her place of birth? _________________ Date of birth? ______________
5.	How long immediately preceding the date of this application has he/she resided in the State of Missouri? ______________________

6.	Is he/she a native born citizen of the United States? ______ Naturalized citizen? _______
7.	If he/she is a naturalized citizen, give the date of admission to citizenship and court in which he/she was admitted to citizenship __________________________________________
8.	In what city, town, or village does he/she pay taxes? ____________________________
9.	Is he/she a legal voter in the City of Cape Girardeau? ______ If so, in what ward does he/she vote? ________
10.	Is the managing officer thereof, or any member of his household or immediate family interested directly or indirectly in any other license issued by the City of Cape Girardeau which is not in force? ______ If so, give details ________________________________ ____________________________________________________________________

11.	Has the managing officer thereof, or any member of his household or his immediate family, at any time in the past held a license from the City of Cape Girardeau? _____________ If so, give name of such licensee and location of premises ________________________ ____________________________________________________________________
12.	Has the managing officer, or any member of his household or immediate family, ever made application for license from the Supervisor of Liquor Control or the City of Cape Girardeau, which was denied? _____ If so, name the applicant, approximate date of denial and details regarding same ________________________________________________________ ____________________________________________________________________
13.	Has the managing officer thereof, or any member of his household or immediate family, ever had ever had any license issued by the Supervisor of Liquor Control of the State of Missouri or by the licensing authority of any state or city suspended or revoked? ______________ If so, give details _______________________________________________________ ____________________________________________________________________
14.	Describe the duties the managing officer performs for the corporation, if any. __________ ____________________________________________________________________
15.	Is the managing officer a stockholder in the corporation? _____

16.	Is the managing officer a member of the Board of Directors of the corporation? _____
17.	Has the managing officer ever been employed by a person, partnership or corporation that has had a license revoked or suspended by the Supervisor of Liquor Control of the State of Missouri? _____ If so, give details ________________________________________ ___________________________________________________________________
18.	Has the managing officer, above named, ever been arrested or indicted for the violation of any Federal Law or law of the State of Missouri or of any other state? __________ If so, give details _____________________________________________________ __________________________________________________________________
19.	Has the managing officer ever been convicted of any crime in any Missouri Court or in any court of any other state or country, or any Federal court? _____ If so, give details _____________________________________________________ __________________________________________________________________
20.	Has he/she ever been convicted of the violation of any ordinance of any city relating to intoxicating liquor, gambling, immorality, fighting, or peace disturbance? _____ If so, give details _____________________________________________________ __________________________________________________________________

21.

Has the managing officer above named, or any member of his household or his immediate family, ever been convicted of any Federal law, or law of any state concerning intoxicating liquor? _____ If so, give details as to each conviction, giving name of person convicted, date, nature of offense, court where sentence was entered, and sentence or fine imposed
__________________________________________________________________
__________________________________________________________________

22.

Who is your landlord? _________________________________________________

23.	Does the managing officer above named have any interest directly or indirectly in any brewery, winery, distillery, rectifying or blending plant or wholesale liquor concern either as part owner, stockholder, agent employee, or otherwise? _____ If so, give details _____________________________________________________ __________________________________________________________________
24.	Has any bonding company ever refused to sign a bond for the managing officer? _____ If yes, state what circumstances __________________________________________ __________________________________________________________________

___________________________ of lawful age, being first duly sworn upon his/her oath, deposes and says that he/she is the managing officer of the corporation seeking a license hereunder, that has been authorized by said corporation to make this application in its behalf, that he/she has read this application and the instructions with reference thereto, and that he/she fully understands the same and that he/she knows the contents thereof and the answers and statements contained therein and the same are true.

	____________________________________________ Exact Corporation Name of Applicant
	by _________________________________________